ARTICLE: A National Physician Survey of Deintensifying Diabetes Medications for Older Adults With Type 2 Diabetes
AUTHORS: Scott J Pilla, Rabia Jalalzai, Olive Tang, Nancy L Schoenborn, Cynthia M Boyd, Sherita H Golden, Nestoras N Mathioudakis, Nisa M Maruthur
JOURNAL: . 2023 Jun 1;46(6):1164-1168. doi: 10.2337/dc22-2146.
Abstract
Objective: To determine physicians' approach to deintensifying (reducing/stopping) or switching hypoglycemia-causing medications for older adults with type 2 diabetes.
Research design and methods: In this national survey, U.S. physicians in general medicine, geriatrics, or endocrinology reported changes they would make to hypoglycemia-causing medications for older adults in three scenarios: good health, HbA1c of 6.3%; complex health, HbA1c of 7.3%; and poor health, HbA1c of 7.7%.
Results: There were 445 eligible respondents (response rate 37.5%). In patient scenarios, 48%, 4%, and 20% of physicians deintensified hypoglycemia-causing medications for patients with good, complex, and poor health, respectively. Overall, 17% of physicians switched medications without significant differences by patient health. One-half of physicians selected HbA1c targets below guideline recommendations for older adults with complex or poor health.
Conclusions: Most U.S. physicians would not deintensify or switch hypoglycemia-causing medications within guideline-recommended HbA1c targets. Physician preference for lower HbA1c targets than guidelines needs to be addressed to optimize deintensification decisions.
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